Nineteenth Century Medical Guide

Chapter 239 235. Ward rounds [2]

Hospital rounds have existed since ancient times.

To put it simply, when a doctor wants to understand the patient's current condition and changes after medication, he needs to repeatedly check the patient's physical condition, and there is a ward round.

But this is limited to internal medicine. In the 19th century, when disinfection measures were just emerging, surgical ward rounds were more about allowing doctors to see clearly the results of their own operations, that is, the patient's life and death.

Of course, internal medicine is not much better. The only difference is that internal medicine will rack its brains to provide new treatment methods, while surgery can only quietly watch the postoperative incision fester slowly affect the patient's whole body until he finally dies.

The end result was the same, the patient died, but in the eyes of the patient, the physician repeatedly changed the treatment method, obviously trying his best, but the surgery could not do anything, it should be just a problem with the operation.

Patient responses and outcomes also feed back on physicians, altering their treatment styles.In the end, it will evolve into a very embarrassing pattern.Surgery no longer performed operations or rarely performed operations, while internal medicine raised the banner of bloodletting therapy.Although this situation has eased in the middle of the 19th century, it is still the mainstream of military hospitals.

To this day, Prussian military doctors still maintain a more traditional practice.If you can bandage, you can bandage, and if you can't bandage, you choose to perform surgery.The mode of operation is still to cut away those wounds that cannot heal, that is, amputation.

As for the ward rounds that Carvey has been emphasizing, they are doing them twice a day, at 9 am and 11 pm.

This is the rule set by the British during the Napoleonic Wars, and it also includes that there must be one head nurse and six nurses for every 100 hospital beds.Hiring women was still illegal at the time, but there were still many who included soldiers' wives in the ranks of medics.

Prussia perfectly inherited this rule and also learned some lessons from the Crimean War.

It is a pity that learning lessons has not fundamentally changed the rules of the game for military doctors. Postoperative care requires not only knowledge and experience, but also the most fundamental infrastructure construction.

"26 people have died since the 550th." A head of the Prussian military medical office was reporting to Lieutenant General Gustaf stationed in Gran Seni on the logistics work of the military medical staff in the past few days. More than 300 wounded soldiers died here, and the daily death toll was controlled within 100 through the work of our military doctors.”

"Fles, you did a good job. Not only did you complete your job well, but you also showed excellent commanding skills." Gustav was not surprised when he saw the report sent to him, "Actually Where there are undead in war, there is no need to make such a fuss."

"The death rate is over 45 percent."

"Well, by the way, are the corpses buried? I don't want a plague in Granseny."

"It's all buried."

"It's really good, you guys did your best."

In Gustav's eyes, 90% of the work of a military doctor is completed as long as he can treat the wounded, give comfort to the wounded, and bury the corpse well.The rest of the work didn't help much in the war, and he didn't understand it, so there was no need for him to report it.

However, the person in charge of the military medical department named Fries is not here to claim credit: "I hope to improve the environment of the hospital ward, at least expand some rooms. It has been raining lightly for the past few days. If the war continues If we go down, many wounded soldiers will have no place to live."

"Those houses can be requisitioned." Gustav said, "The hospitals in the suburbs can also be called temporarily, which is not difficult."

Ferris nodded, and quickly got the military order from the lieutenant general: "There is one more thing."

"please say."

"The hospital can be expanded, but the number of doctors is fixed. It would be inappropriate to send all wounded soldiers to the rear."

Fries still had a register in his hand, on which was densely written a bunch of information related to wounded soldiers: "Some soldiers' injuries don't need to be sent here at all, and they can heal themselves on the front line. It’s meaningless, I just did a simple bandage when I came here, and I died within two days, it’s not as good as it.”

"How about it?" Gustav smiled, got up and picked up a cigar from the table, "Why don't you put it on the front line and wait to die?"

Fries gritted his teeth and admitted: "For the normal operation of this hospital, this is unavoidable. As you said just now, casualties will definitely exist. Our military doctors can only ensure that all soldiers are treated as soon as possible. Get treatment, not come here and wait in line to die."

[Innocent]
Gustav muttered something in a low voice, but did not say clearly, but asked, "How are the military doctors doing now?"

"Work 10 hours a day." This is also a question that Fries wanted to ask. I wanted to report it at the end, but I didn't expect the other party to ask it first. "For example, I get up at 7 in the morning and may have to work until You can only rest at 9 o'clock in the evening. All the doctors and nurses here are working beyond the normal range, and everyone is very tired."

"Since there are so many wounded soldiers, you might as well work two more hours."

Ferris didn't understand what he meant: "What did you say?"

"Since there are more wounded soldiers, the doctors will naturally have to work more." Gustav used the simplest example, "It's like the current frontline battlefield. If Austria increases its troops, then we have to continue to increase our troops." Row."

"If you want to say that, it should be the doctor who should be added."

"I can't do it." Gustav suddenly paused for a moment, "Maybe you can go to the surrounding countryside to find some amputee surgeons."

"No, those crappy surgeons can't do it well!"

"So I'm right, increasing your hours will take care of it."

Ferris was a little bit broken: "Add more hours to work, and we will all be exhausted."

"You see, you also know that this is not appropriate." Gustav smiled, leaning on the back of the chair, and said, "The firearms on the modern battlefield have long been beyond the capabilities of military doctors. This is what you must do after the development of the times. Facing the facts. How can it be possible to save all soldiers without increasing the workload?"

"But."

"I know that there are indeed some problems with the transfer, but it's not a big problem." Gustav affirmed his work, "The military medical department has done a good job in general, and I will write down your deeds of fulfilling your duties in the letter and send them to Go to the staff office."【1】

"Your Excellency, Lieutenant General, we should make a change. This is the existing malpractice of the Military Medical Department."

Gustav shook his head and said with a smile: "Our battles on the front line are becoming fiercer, but the overall situation is in our favor, and any change will change this situation. The instructions of the staff office are very clear, to hold back the Austrians on the northern front , the First Army will attack Austria from the western front, making it hard for them to look back."

"But we can't just watch soldiers die in vain."

Gustav's face turned cold, he took down the cigar in his mouth, and exhaled a puff of smoke: "Your words are a bit too much, they are defending the iron-blooded spirit of Prussia!

You know, there were more dead and wounded in Austria, and those wounded who survived the first round of fire were more seriously injured than our soldiers.Don't worry, based on what I know about the Austrians, they won't be able to bear this kind of casualties and choose to retreat in a day or two. "

The military doctor's opinion really hit the key point in the medical treatment of the Prussian army today, but he didn't know that it was not easy to complete the transfer method like Kavi.

In order to complete the batch transfer system, the frontline military doctors must be raised to a very professional level, otherwise everything is empty talk.For this alone, a lot of military medical training needs to be done before the war begins, which is simply impossible for Prussia today.

The improvement of professional level is not something that can be done casually, but also requires the most critical "Military Doctor Manual", the serious gold standard of modern trauma surgery.

As for the number of medical tents, equipment and medicines needed to accompany the troops on the front line, it will also greatly increase the logistical burden, and the matching horses and engineers for the construction of temporary medical offices need to be calculated and further distributed.

It took Kavey four full months to barely reach the current situation. Prussia's changes now may really cause some unpredictable situations.

Of course, today's Austrian army is not peaceful, and Gustav's high casualty rate is not wrong.The advanced breech-loading guns overwhelmed the Austrian army, and no matter how strong the rear hospitals were, they could not withstand the doubled number of wounded.

Although the death rate in the Olmitz Fortress Hospital is not high, the death toll is no less than that of Prussia because of the large base.

After three days, there were more than 500 dead soldiers, and Kawei witnessed a high turnover rate that he had never seen before: "If it is placed in modern times, this turnover rate is simply against the sky."

"Dean, what did you just say?"

"Oh, nothing." Carvey took two sips of coffee, stuffed half a piece of bread into his mouth, and asked, "Are the medical records ready?"

"It's all ready."

"Then let's go and continue the rounds."

Generally speaking, surgical ward rounds are more concise than those of internal medicine. The focus is generally on the incision, the drainage of the surgical area, the basic condition of the patient, and whether there are surgical complications.

Generally, if the first three are all right, the operation can be regarded as a basic success, and the complications are often unpredictable, because no matter how beautiful the operation is, there is still a chance of complications.

After all, it is a manual operation, and there will always be more or less errors that are difficult to detect with the naked eye. Coupled with individual differences between human bodies, no one knows what will happen after the operation.

Even if the previous 100 operations were all successful, as long as one operation fails, a review is required to find out the problem.Then make statistical calculations on the postoperative results, and finally get an approximate probability of occurrence.

Perhaps the prevention of such complications will be discovered after a few years, but doctors cannot eliminate the probability of a certain surgical complication to zero.

Because of the risks of the surgery itself and the existence of complications, postoperative ward rounds and medical history records have become the last resort for surgery, which is the product of hundreds of years of doctors' experience.If I had to choose a typical example, it would be Ronagne who was still lying in the ward with his eyes closed.

If it is a modern surgery, Ronagne's condition is a very critical patient who has been properly monitored in the ICU after the operation.

Expert consultation may have been done before the operation, and the focus is still on the extent of debridement and how to deal with bleeding.After surgery, you have to face stubborn cerebral edema, as well as a scalp that cannot completely cover the brain tissue and a ruptured skull. Perhaps only after consultation in the department can you find the best postoperative recovery plan.

But in the 19th century, it was already a miracle that Ronagne survived the operating table.

"The two nurses have worked hard, and I asked you to keep pinching the airbag." Carvey does not have a simple ventilator in his hand. Facing a patient whose brainstem is squeezed, his breathing is very unstable, so he can only supply oxygen by pinching the airbag. "Have you changed shift?" ?”

"Hurry up, there are still two hours." The nurse was really tired after pinching the airbag all night.

Carvey sighed and asked, "How is his drainage now?"

"Still a lot, bloody."

"What about body temperature?"

"38.4°C."

"Continue to use the medicine, measure the pressure of the cerebrospinal fluid again at night, and you continue to observe, especially the changes in blood pressure." Carvey looked at the gauze covering Ronagne's head, "After the cerebral edema subsides, do a simple scalp Stitch up and hopefully the infection will be better by then."

After the brain debridement, he has been in a coma. If there is no postoperative follow-up, he would have died of severe cerebral edema caused by the surgical debridement last night.

"Let's see the next one." Carvey turned to look at Rogerini who was sleeping on the other side of the bed, and asked, "Are you awake?"

"Yes, I'm awake." Rogerini was weak and could only speak a few words.

"how do you feel?"

“It hurts a little bit”

Kavey nodded, and asked Gorham beside him, "How much is drained under the xiphoid process?"

Gorham Report: "Now 10ml."

"It's not bad." Carvey wanted to step forward to have a look at the incision, but never thought that there would be a patient also wearing a hospital gown standing beside the bed, "Come on, let me check the incision."

Unexpectedly, the patient just walked a few steps in and leaned against the wall, and did not choose to leave.Carvey still has a lot of modern doctor-patient relationship concepts, and the operation was very successful, and there were no other troubles after the operation, so he was in a good mood, so he didn't drive him away.

He briefly glanced at the gauze on the incision, there was not much leakage, and asked about the vital signs, which seemed to be completely normal.Only then did Carvey remember to ask the following surgeons: "Do you still remember how to diagnose pericardial tamponade?"

"Weakened heartbeat, dilated jugular veins, and"

"There are five symptoms in total. In addition to these two, there is also a decrease in pulse pressure difference, and"

Carvey sighed: "You don't remember?"

"I remember, it's just that I didn't remember everything at the time when I spoke too fast."

Carvey repeated the possible symptoms of pericardial tamponade: "The most important thing is shock. The bleeding from the heart rupture is so serious, you can't forget the shock. Next is to look at the jugular vein. Because the heart is bound, it returns The blood volume of the heart decreases, and the jugular veins will be distended. Then, when auscultation is performed, the heart sounds will be very distant.

In addition, there is a very fast heart rate. Rogerini's heart rate exceeded 140 beats per minute before, and finally he was emotionally restless, which needs to be distinguished from the reaction after drinking. "

At this moment, besides hearing the swift notes of the people around me, someone suddenly asked, "Excuse me, do the five syndromes of Karl's syndrome have to be present at the same time to diagnose pericardial tamponade?"

Carvey was stunned, never thought that the original Beck triad would be changed to his own name, it was almost the same as the previous cesarean section: "Actually, there is no need to write my name on it, just say the five syndromes of pericardial tamponade Zheng is better to remember."

"That's too long to remember."

"Adding the name is cool enough, Karl's cesarean section, Karl's cranial debridement, Karl's heart repair."

　Is it a big flu? It's obviously too much. At most, it's called a big flu. I don't agree with it.I don’t know if you have had the flu. The course of the disease is likely to be three days, with a high fever of about 39 degrees, and more than 90% of them are fine.The past three days have been very uncomfortable, my whole body is cold, my muscles are sore, I have no strength, and I can't eat anything except drinking water, but it passes after a while. 10% of those who have something to do will have pneumonia, and the mortality rate is available online.The symptoms of the new crown are definitely stronger than those of the flu. The reason why there is not much difference in physical sensation is because of the weakened virulence + three-shot vaccine.The trouble now is the contagion, any probability will turn into a huge number in front of a huge sample.I have only had the flu once so far, and the contagion is simply incomparable.So, take care of each other, and finally attach a medication chart [Follow the doctor's advice]

　　
　
(End of this chapter)